Molecular identification of Nocardia species causing endophthalmitis using multilocus sequence analysis (MLSA): a 10-year perspective

Zhang

et al. 2022

Front. Public Health

Nocardia endophthalmitis is a relatively uncommon form of endophthalmitis seen in clinical patients. In general, Nocardia endophthalmitis tends to carry a poor prognosis. Here, we report a 3-year-old child who was admitted to the hospital due to a rupture of the left eye. The suturing and anterior chamber formation were performed immediately. Approximately, 16 days after the operation, massive whitish plump and tufted exudates gathered in the pupil area and at the bottom of the anterior chamber, and the child was diagnosed with endophthalmitis. The infection was initially considered to be caused by fungal pathogens for that the hyphae and spores were observed in the smear. However, the isolate obtained after 4 days of culturation was identified as actinomycetes using MALDI–TOF. We further classified it as Nocardia huaxiensis by next-generation sequencing (NGS) based on the MinION platform. Amikacin and sulfamethoxazole tablets were used to control the infection and the ocular inflammation subsided gradually. Intraocular lens (IOL) implantation is planned to be performed at an appropriate future time to improve his vision. Nocardia endophthalmitis is rare and usually caused by ocular trauma or surgery. In conclusion, Nocardia huaxiensis should be considered as an emerging pathogen and deserves more attention.

Section: Discussionmentioning

confidence: 99%

Case Report: First Case of Endophthalmitis Caused by an Emerging Pathogen: Nocardia huaxiensis

Zhang

et al. 2022

Front. Public Health

“…Phylogenetic trees were constructed using the neighbor-joining (NJ) genetic distance method [ 33 ] and performed using the ClustalW algorithm in the mega X software. The reliability of each tree topology was checked using 10,000 bootstrap replications [ 32 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of Nocardia Species at a Tertiary Hospital in Southern Taiwan, 2012 to 2020: MLSA Phylogeny and Antimicrobial Susceptibility

et al. 2022

The identification and antimicrobial susceptibility of Nocardia spp. are essential for guiding antibiotic treatment. We investigated the species distribution and evaluated the antimicrobial susceptibility of Nocardia species collected in southern Taiwan from 2012 to 2020. A total of 77 Nocardia isolates were collected and identified to the species level using multi-locus sequence analysis (MLSA). The susceptibilities to 15 antibiotics for Nocardia isolates were determined by the broth microdilution method, and the MIC50 and MIC90 for each antibiotic against different species were analyzed. N. cyriacigeorgica was the leading isolate, accounting for 32.5% of all Nocardia isolates, and the prevalence of Nocardia isolates decreased in summer. All of the isolates were susceptible to trimethoprim/sulfamethoxazole, amikacin, and linezolid, whereas 90.9% were non-susceptible to cefepime and imipenem. The phylogenic tree by MLSA showed that the similarity between N. beijingensis and N. asiatica was as high as 99%, 73% between N. niigatensis and N. crassostreae, and 86% between N. cerradoensis and N. cyriacigeorgica. While trimethoprim/sulfamethoxazole, amikacin, and linezolid remained fully active against all of the Nocardia isolates tested, 90.9% of the isolates were non-susceptible to cefepime and imipenem.

J Clin Images Med Case Rep

“…Notably, the radiographic findings mainly include abscess, cavity, Ground-glass opacity and miliary changes. Due to these characteristics, Nocardia is also known as the great masquerader as it excellently camouflages as tuberculosis [4][5][6][7][8]. According to current studies, Coinfection with tuberculosis and Nocardia occurs in about 1% of the population, while the co-infection rate among HIV patients ranges from 3% to 6.25 [6,9].…”

Section: Introductionmentioning

confidence: 99%

Co-infection with nocardia and mycobacterium tuberculosis in a patient with systemic lupus erythematosus: A case report

Jiang¹,

Xu²,

Wu³

et al. 2021

Objective: Pulmonary infection is an important cause of morbidity and death in immunosuppressed patients. Recent studies showed that infections caused by Nocardia are quite rare, especially mixed infections with Nocardia and Mycobacterium Tuberculosis (MTB). This case emphasizes the importance of being alert to the possibility of co-infection in immunosuppressed patients. Case description: A 31-year-old female patient presented to the outpatient clinic with recurrent fever and cough. She had also suffered from Systemic Lupus Erythematosus (SLE) and type V lupus nephritis for 8 years. Additionally, she tested positive for the Nocardia nova complex and MTB following culture of the sputum/bronchoalveolar lavage fluid (BALF) and lung tissue. Initial Computed Tomography (CT) showed a bi-pulmonary massive high-density shadow with multiple cavities, Ground-Glass Opacity (GGO) and multiple miliary nodules. After admission, the patient was given Cefoperazone-Sulbactam (CSL) for empiric treatment and also received low-flow oxygen therapy. Four days later, microscopic examination suggested infection with Nocardia and CSL was replaced with Trimethoprim/Sulfamethoxazole (SXT), Moxifloxacin (MFX) and Imipenem (IPM). On the 9th day, the Nocardia nova complex was confirmed although there was a significant improvement in pulmonary symptoms and imaging results. However the images showed that there was no significant change in GGO and miliary nodules. Moreover, 18 days later she was confirmed with MTB infection and was subsequently transferred to the infectious diseases hospital for further treatment. Conclusion: Immunosuppressed patients have higher morbidity and mortality after opportunistic infection with pulmonary pathogens such as Nocardia and MTB. Therefore, early detection of pathogens and selection of appropriate antimicrobial therapy can significantly improve the prognosis.